The Effects of Maxillary Protraction with or without Rapid Maxillary Expansion and Age Factors in Treating Class III Malocclusion: A Meta-Analysis

The orthodontic treatment of Class III malocclusion with a maxillary deficiency is often treated with maxillary protraction either with or without maxillary expansion. The routine procedure for rapid maxillary expansion includes banding on first premolars/first deciduous molars and the permanent first molars. However in some patients who are esthetically very conscious, banding of the first premolar would not be a good esthetic option. So for such circumstances we have designed a modified hyrax splint, which does not need the first premolars to be banded.

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Postpubertal Effects of the Rapid Maxillary Expansion and Facial Mask versus the Removable Mandibular Retractor for the Early Treatment of Class III Malocclusion: A Study on Lateral Cephalograms

Applied Sciences ◽

10.3390/app11188393 ◽

2021 ◽

Vol 11 (18) ◽

pp. 8393

Author(s):

Veronica Giuntini ◽

Matteo Camporesi ◽

Valeria Barone ◽

Matilde Marino Merlo ◽

Cosimo Nardi ◽

...

Keyword(s):

Early Treatment ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Facial Mask ◽

Skeletal Class ◽

Maxillary Protraction ◽

Time Points ◽

Lateral Cephalograms

The aim of this study was to compare the efficacy of early treatment of Class III malocclusions with rapid maxillary expansion (RME) and facial mask (FM) versus the removable mandibular retractor (RMR) re-evaluated at a postpubertal observation on lateral cephalograms. All prepubertal patients with Class III malocclusion treated consecutively from 1986 to 2013 by means of RME/FM or RMR were analyzed. Twenty-nine patients treated with RME/FM therapy and 23 patients treated with RMR were selected. Lateral cephalograms were available at 3 time points, before treatment (T1), at the end of active treatment (T2), and at a postpubertal observation (T3). Statistical comparisons were performed with independent sample t tests or Mann–Whitney tests. During the T1–T3 interval, a significantly greater maxillary protraction (SNA +1.5 mm, p = 0.031) and significantly greater improvements in ANB and Wits appraisal (+1.9 degrees, p = 0.002, and +2.2 mm, p = 0.012, respectively) were recorded in the RME/FM group. No statistically significant changes could be found in vertical skeletal measurements. In the dentoalveolar region, the RME/FM group showed a significantly greater correction of the molar relationship (−1.5 mm, p = 0.021). Early treatment of Class III malocclusion with RME/FM protocol in comparison with RMR protocol showed a greater maxillary advancement and greater improvements in sagittal skeletal Class III relationships.

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Long-term maxillary anteroposterior changes following maxillary protraction with or without expansion: A meta-analysis and meta-regression

PLoS ONE ◽

10.1371/journal.pone.0247027 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0247027

Author(s):

Wei-Cheng Lee ◽

Yi-Shing Shieh ◽

Yu-Fang Liao ◽

Cho-Hao Lee ◽

Chiung Shing Huang

Keyword(s):

Confidence Interval ◽

Meta Analysis ◽

Rapid Maxillary Expansion ◽

Mean Difference ◽

Class Iii ◽

Maxillary Expansion ◽

Maxillary Protraction ◽

Meta Regression

Background Maxillary protraction with or without expansion is a widely known orthopedic treatment modality in growing skeletal Class III patients. However, limited data are available regarding the outcomes of long-term changes in the maxilla. Aim of this meta-analysis was to assess the effectiveness of the long-term maxillary anteroposterior changes following a facemask therapy with or without rapid maxillary expansion in growing skeletal Class III patients. Methods A comprehensive literature search was conducted using the databases of PubMed, Science Direct, Web of Science, and Embase. Randomized controlled trials and cohort studies, published up to Sep. 2020, with maxillary protraction and/or expansion as keywords were included in this meta-analysis. Risk of bias within and across studies were assessed using the Cochrane tools (RoB2.0 and ROBINS-I) and GRADE approach. Overall and subgroup comparisons with the random-effect model were performed in this meta-analysis. Meta-regression models were designed to determine potential heterogeneity. Results There was a statistically significant increase (Mean difference, 2.29°; 95% confidence interval, 1.86–2.73; and p < 0.001 after facemask (FM) protraction. Mean difference, 1.73°; 95% confidence interval, 1.36–2.11; and p < 0.001 after rapid maxillary expansion(RME) and facemask protraction) in the Sella-Nasion-A point (SNA) angle in the treatment groups as compared with the control groups, when measured during the less than 3-year follow-up period. However, no statistically significant changes (Mean difference, 0.28°; 95% confidence interval, -0.57–1.13; and p = 0.52 after facemask protraction. Mean difference, 0.34°; 95% confidence interval, -0.64–1.33; and p = 0.50 after rapid maxillary expansion and facemask protraction) were observed in the SNA angle in the groups, when measured after 3 years of follow-up. Meta-regression analysis also showed that with increased follow-up duration, the effectiveness of maxillary protraction decreased. Conclusion This meta-analysis revealed that maxillary protraction therapy could be effective for a short-term in correcting maxillary hypoplasia and the treatment result was not affected by mean age and sex. However, with increased follow-up duration, the sagittal maxillary changes gradually decreased. Limitations on this review were only the SNA angle was used and clinical heterogeneity was not discussed. The quality of evidence was moderate. Further long-term observational studies are necessary for a comprehensive evaluation of the effects on maxillary skeletal changes.

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Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction

American Journal of Orthodontics and Dentofacial Orthopedics ◽

10.1016/s0889-5406(98)70292-6 ◽

1998 ◽

Vol 113 (2) ◽

pp. 196-203 ◽

Cited By ~ 76

Author(s):

Omar Gabriel da Silva Filho ◽

Adriana Cecilia Magro ◽

Leopoldino Capelozza Filho

Keyword(s):

Early Treatment ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Maxillary Protraction

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Alternate rapid maxillary expansion and constriction (Alt-Ramec) — A review

IP Journal of Surgery and Allied Sciences ◽

10.18231/j.jsas.2021.009 ◽

2021 ◽

Vol 3 (2) ◽

pp. 30-33

Author(s):

Sanjana Shetty ◽

Shilpa Pharande ◽

Naazia Shaikh

Keyword(s):

Efficient Method ◽

Early Treatment ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Skeletal Class ◽

Maxillary Protraction ◽

Opening And Closing ◽

Dentofacial Orthopedics

Treating Class III malocclusion is a challenge for orthodontists. It is best to treat it at growing stage with Dentofacial Orthopedics. Alt-RAMEC protocol was introduced by Liou in the year 2005. It allows for sutural mobilisation by opening and closing the RME screw for 7-9 weeks. Maxillary protraction after the use of Alt-Ramec protocol is an efficient method for early treatment skeletal Class III malocclusion. The objective of this review is to explain to the clinicians a modified and efficient method for treatment of skeletal Class III malocclusion in growing patients.

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Early correction of class III malocclusion with rapid maxillary expansion and face mask therapy

Journal of Pharmacy And Bioallied Sciences ◽

10.4103/0975-7406.114325 ◽

2013 ◽

Vol 5 (6) ◽

pp. 169 ◽

Cited By ~ 5

Author(s):

Muthukumar Karthi ◽

GobichettipalayamJagatheeswaran Anbuselvan ◽

BhandariPawan Kumar

Keyword(s):

Face Mask ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Early Correction

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Assessment of Immediate Skeletal Changes after Alternate Rapid Maxillary Expansion and Constriction – A Case Report

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/604 ◽

2021 ◽

Vol 10 (34) ◽

pp. 2954-2959

Author(s):

Shilpa Venkatesh Pharande

Keyword(s):

Case Report ◽

Rapid Maxillary Expansion ◽

Class Iii ◽

Class Iii Malocclusion ◽

Maxillary Expansion ◽

Skeletal Class ◽

Posterior Crossbite ◽

Skeletal Changes ◽

Before And After ◽

Opening And Closing

The Alt-RAMEC protocol was introduced by Liou in the year 2005. It allows for sutural mobilisation by opening and closing the RME screw for 7-9 weeks. Maxillary protraction after the use of Alt-Ramec (alternate rapid maxillary expansion and contraction) protocol is an efficient method for early treatment of skeletal Class III malocclusion. This case report shows the results of using a hyrax bonded maxillary expander with the Alt-RAMEC protocol to treat a maxillary hypoplasia Class III malocclusion. A 12-year-old patient with skeletal class III malocclusion with anterior as well as the unilateral posterior crossbite was treated using this protocol. CBCT scans were taken before and after expansion. These CBCT scans were used for assessing and analysing the skeletal changes that have occurred after using the AltRamec protocol. The objective of this case report is to assess skeletal changes after using the Alt-RAMEC protocol.

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